Please use this identifier to cite or link to this item: http://hdl.handle.net/10668/715
Title: Management of bleeding following major trauma: a European guideline
Authors: Spahn, Donat R
Cerny, Vladimir
Coats, Timothy J
Duranteau, Jacques
Fernández-Mondéjar, Enrique
Gordini, Giovanni
Stahel, Philip F
Hunt, Beverley J
Komadina, Radko
Neugebauer, Edmund
Ozier, Yves
Riddez, Louis
Schultz, Arthur
Vincent, Jean-Louis
Rossaint, Rolf
metadata.dc.contributor.authoraffiliation: [Spahn,DR] Department of Anesthesiology, University Hospital Zurich, Zurich, Switzerland. [Cerny,V] Charles University in Prague, Faculty of Medicine in Hradec Králové, Department of Anaesthesiology and Intensive Care Medicine, University Hospital Hradec Králové, Hradec Králové, Czech Republic. [Coats,TJ] Leicester Royal Infirmary, Accident and Emergency Department, Leicester,UK. [Duranteau,J] Department of Anaesthesia and Intensive Care, University of Paris XI Faculté de Médecine Paris-Sud,Le Kremlin-Bicêtre, France. [Fernández-Mondéjar,E] Department of Emergency and Critical Care Medicine, University Hospital Virgen de las Nieves, Granada, Spain. [Gordini,G] Department of Anaesthesia and Intensive Care, Ospedale Maggiore, Bologna, Italy. [ Stahel,PF] Department of Orthopaedic Surgery, Denver Health Medical Center, University of Colorado Medical School, Denver, USA. [Hunt,BJ] Departments of Haematology, Pathology and Rheumatology, Guy's & St Thomas' Foundation Trust, London, UK. [Komadina,R] Department of Traumatology, General and Teaching Hospital Celje, Celje, Slovenia. [Neugebauer,E] Institute for Research in Operative Medicine, University of Witten/Herdecke, Köln (Merheim), Germany. [Ozier,Y] Department of Anaesthesia and Intensive Care, Université René Descartes, Paris, Hopital Cochin, Paris, France. [Riddez,L] Department of Surgery and Trauma, Karolinska University Hospital, Solna, Sweden. [Schultz,A] Ludwig-Boltzmann-Institute for Experimental and Clinical Traumatology, Vienna, Austria. [Vincent,JL] Department of Intensive Care, Erasme Hospital, University of Brussels, Belgium, Brussels, Belgium. [Rossaint,R] Department of Anaesthesiology, University Hospital Aachen, Aachen, Germany.
Keywords: Blood Substitutes;Trastornos de la coagulación sanguínea;Sustitutos sanguíneos;Transfusión sanguínea;Embolización terapéutica;Tratamiento de urgencia;Hemorragia;Técnicas hemostáticas;Humanos;Resucitación;Choque hemorrágico;Factores de Tiempo;Heridas y Traumatismos;Cuestionarios;Trastornos Somatosensoriales;España;Síndrome;Traducciones;Antifibrinolytic Agents
metadata.dc.subject.mesh: Medical Subject Headings::Diseases::Hemic and Lymphatic Diseases::Hematologic Diseases::Blood Coagulation Disorders
Medical Subject Headings::Chemicals and Drugs::Chemical Actions and Uses::Pharmacologic Actions::Therapeutic Uses::Hematologic Agents::Blood Substitutes
Medical Subject Headings::Analytical, Diagnostic and Therapeutic Techniques and Equipment::Therapeutics::Biological Therapy::Blood Transfusion
Medical Subject Headings::Analytical, Diagnostic and Therapeutic Techniques and Equipment::Therapeutics::Hemostatic Techniques::Embolization, Therapeutic
Medical Subject Headings::Analytical, Diagnostic and Therapeutic Techniques and Equipment::Therapeutics::Emergency Treatment
Medical Subject Headings::Diseases::Pathological Conditions, Signs and Symptoms::Pathologic Processes::Hemorrhage
Medical Subject Headings::Analytical, Diagnostic and Therapeutic Techniques and Equipment::Therapeutics::Hemostatic Techniques
Medical Subject Headings::Organisms::Eukaryota::Animals::Chordata::Vertebrates::Mammals::Primates::Haplorhini::Catarrhini::Hominidae::Humans
Medical Subject Headings::Analytical, Diagnostic and Therapeutic Techniques and Equipment::Therapeutics::Emergency Treatment::Resuscitation
Medical Subject Headings::Diseases::Pathological Conditions, Signs and Symptoms::Pathologic Processes::Hemorrhage::Shock, Hemorrhagic
Medical Subject Headings::Phenomena and Processes::Physical Phenomena::Time::Time Factors
Medical Subject Headings::Diseases::Wounds and Injuries
Issue Date: 13-Feb-2007
Publisher: BioMed Central
Citation: Spahn DR, Cerny V, Coats TJ, Duranteau J, Fernández-Mondéjar E, Gordini G et al.Management of bleeding following major trauma: a European guideline. Crit Care. 2007;11(1):R17.
Abstract: INTRODUCTION Evidence-based recommendations can be made with respect to many aspects of the acute management of the bleeding trauma patient, which when implemented may lead to improved patient outcomes. METHODS The multidisciplinary Task Force for Advanced Bleeding Care in Trauma was formed in 2005 with the aim of developing guidelines for the management of bleeding following severe injury. Recommendations were formulated using a nominal group process and the GRADE (Grading of Recommendations Assessment, Development, and Evaluation) hierarchy of evidence and were based on a systematic review of published literature. RESULTS Key recommendations include the following: The time elapsed between injury and operation should be minimised for patients in need of urgent surgical bleeding control, and patients presenting with haemorrhagic shock and an identified source of bleeding should undergo immediate surgical bleeding control unless initial resuscitation measures are successful. A damage control surgical approach is essential in the severely injured patient. Pelvic ring disruptions should be closed and stabilised, followed by appropriate angiographic embolisation or surgical bleeding control, including packing. Patients presenting with haemorrhagic shock and an unidentified source of bleeding should undergo immediate further assessment as appropriate using focused sonography, computed tomography, serum lactate, and/or base deficit measurements. This guideline also reviews appropriate physiological targets and suggested use and dosing of blood products, pharmacological agents, and coagulation factor replacement in the bleeding trauma patient. CONCLUSION A multidisciplinary approach to the management of the bleeding trauma patient will help create circumstances in which optimal care can be provided. By their very nature, these guidelines reflect the current state-of-the-art and will need to be updated and revised as important new evidence becomes available.
Description: Journal Article; Practice Guideline;
URI: http://hdl.handle.net/10668/715
metadata.dc.relation.publisherversion: http://ccforum.com/content/11/1/R17
metadata.dc.identifier.doi: 10.1186/cc5686
ISSN: 1466-609X (Online)
1364-8535 (Print)
Appears in Collections:01- Artículos - Hospital Virgen de las Nieves

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